The prognostic significance of extent of hibernating myocardium and ventricular remodeling in patients with IHF: a comparative study of medical and revascularization therapy

1662 Objectives: We aimed to assess hibernation myocardium (HM) and left ventricular remodeling (LVR) by gated myocardial perfusion imaging (GMPI) and gated 18F-FDG PET/CT(GPET) in patients with ischemic heart failure (IHF), further to evaluate the medium to long-term survival of IHF patients who treated by medicine or revascularization. Methods: Three hundred and forty consecutive IHF patients (LVEF≤35%) who underwent GMPI and GPET imaging were followed up for a median of 2.2 y (range, 0.1-4.3 y). All-cause death during follow-up served as the only endpoint. Patients were classified into 4 groups according to HM (\u003e10%) and LVR (GPET ESVi \u003e70 mL/m2) information. Cox proportional hazards regression analysis model identified the independent predictor for all-cause death. The estimated survival curve was analyzed and compared with the log-rank test. Results: A total of 60 patients (17.6%) died. The highest survival (100%) was observed in patients without HM and without LVR (n=52), whereas the lowest survival (67.2%±8.0%) was observed in patients with HM and LVR (n=130) (P\u003c0.01) (Figure 1). In patients with HM, the difference of survival between revascularization(n=114)(84.4% ± 3.7%) and medical therapy (n=89) (54.0%±8.0%) was greater than that difference of survival between revascularization (n=45) (97.7%±2.3%) and medical therapy (n=92) (84.2%±4.1%) in patients without HM, indicating that the benefit of revascularization was greater in patients with HM (Figure 2), though revascularization improved survival in comparison with medial therapy no matter with or without HM. Medium-long term survival of patients with HM and with LVR by revascularization (n=68) (88.2%±3.9%) was higher than that of patients treated by medical therapy (survival) (n=62) (55.6%±8.8%, χ2= 4.58, P = 0.032) (Figure 3B). Multivariate analysis showed that age (HR 1.063, 95% CI 1.028-1.099, P\u003c0.001), ESVI (HR 1.011, 95% CI 1.004-1.019, P = 0.002) and HM (HR 1.020, 95% CI 1.000-1.041, P = 0.05) were independent predictors of all-cause death, respectively.Conclusion: Our study shows that the outcomes of IHF patients could benefit from revascularization in comparison with medical therapy. Presenting of HM and LVR were associated with substantially enhanced cardiac death in patients underwent medical therapy while could be benefit from revascularization. Therefore, revascularization represents the optimal therapy for IHF patient with coronary artery disease. Acknowledgements: This project was sponsored by the National Natural Science Foundation of (81871377), Capital Characteristic Clinical Application Research (Z181100001718071).